• Kennon Heard, Victoria E Anderson, Eric J Lavonas, Richard C Dart, and Jody L Green.
• a Rocky Mountain Poison and Drug Center , Denver Health and Hospitals , Denver , CO , USA.
• Biomarkers. 2018 May 1; 23 (3): 288-292.

ContextSerum paracetamol-protein adducts (PPAs) are a novel potential biomarker of paracetamol exposure. The relationship between serum PPA concentrations and reported paracetamol use in ambulatory adults has not been previously described.Materials And MethodsThis was a cross-sectional study of ambulatory adults. A detailed medication history was obtained from all subjects and subjects were stratified by reported paracetamol use in the 2 weeks prior to enrolment. Serum PPAs were measured in all subjects and correlated with reported dose, time of last ingestion and demographics.ResultsWe enrolled 230 in the paracetamol exposure arm and 74 in the no exposure arm. 98/230 (42.6%)of subjects who reported paracetamol exposure had PPA detected and 68/74 (91.9%) of subjects who denied paracetamol exposure had no PPA detected. PPA concentrations were positively correlated with total paracetamol dose and with more recent ingestion.DiscussionDetection of serum PPA generally reflects paracetamol exposure histories in ambulatory adults. Concentrations are well correlated with reported dose and time from last dose.ConclusionsSerum PPA can be detected with reported therapeutic use of paracetamol but may not be detected in all patients who report taking paracetamol.

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